Conservative or liberal oxygen therapy in adults after cardiac arrest An individual-level patient data meta-analysis of randomised controlled trials

RESUSCITATION

卷:157

Article

Young, Paul J.^1,2  Bailey, Michael^3,4  Bellomo, Rinaldo^3,4,5,6  Bernard, Stephen⁷  Bray, Janet⁷  Jakkula, Pekka^8,9  Kuisma, Markku¹⁰  Mackle, Diane¹  Martin, Daniel^11,12  Nolan, Jerry P.^13,14  Panwar, Rakshit^15,16  Reinikainen, Matti^17,18  Skrifvars, Markus B.^9,19  Thomas, Matt²⁰ 

[1] Med Res Inst New Zealand, Wellington, New Zealand

[2] Wellington Hosp, Intens Care Unit, Wellington, New Zealand

[3] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia

[4] Univ Melbourne, Parkville, Vic, Australia

[5] Austin Hosp, Intens Care Unit, Heidelberg, Vic, Australia

[6] Univ Melbourne, Ctr Integrated Crit Care, Parkville, Vic, Australia

[7] Monash Univ, Dept Epidemiol & Prevent Med, Clayton, Vic, Australia

[8] Univ Helsinki, Dept Perioperat Intens Care & Pain Med, Helsinki, Finland

[9] Helsinki Univ Hosp, Helsinki, Finland

[10] Helsinki Univ Hosp, Dept Emergency Med, Helsinki, Finland

[11] Royal Free Hosp, Intens Care Unit, London, England

[12] Univ Plymouth, Peninsula Med Sch, Plymouth, Devon, England

[13] Univ Warwick, Warwick Clin Trials Unit, Coventry, W Midlands, England

[14] Royal United Hosp, Anaesthesia & Intens Care Med, Bath, Avon, England

[15] John Hunter Hosp, Intens Care Unit, New Lambton Hts, NSW, Australia

[16] Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia

[17] Univ Eastern Finland, Inst Clin Med, Kuopio, Finland

[18] Kuopio Univ Hosp, Dept Anaesthesiol & Intens Care, Kuopio, Finland

[19] Univ Helsinki, Dept Emergency Care & Serv, Helsinki, Finland

[20] Univ Hosp Bristol & Weston NHS Fdn Trust, Intens Care Unit, Bristol, Avon, England

关键词: Oxygen therapy;    Cardiac arrest;    Hypoxic ischaemic encephalopathy;    Hyperoxaemia;    Hypoxaemia;    Randomised controlled trial;    Individual patient data meta-analysis;   

DOI  :  10.1016/j.resuscitation.2020.09.036

来源: Elsevier

【 摘 要 】

Aim: The effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain. Methods: We undertook an individual patient data meta-analysis of patients randomised in clinical trials to conservative or liberal oxygen therapy after a cardiac arrest. The primary end point was mortality at last follow-up. Results: Individual level patient data were obtained from seven randomised clinical trials with a total of 429 trial participants included. Four trials enrolled patients in the pre-hospital period. Of these, two provided protocol-directed oxygen therapy for 60 min, one provided it until the patient was handed over to the emergency department staff, and one provided it for a total of 72 h or until the patient was extubated. Three trials enrolled patients after intensive care unit (ICU) admission and generally continued protocolised oxygen therapy for a longer period, often until ICU discharge. A total of 90 of 221 patients (40.7%) assigned to conservative oxygen therapy and 103 of 206 patients (50%) assigned to liberal oxygen therapy had died by this last point of followup; absolute difference; odds ratio (OR) adjusted for study only; 0.67; 95% CI 0.45 to 0.99; P = 0.045; adjusted OR, 0.58; 95% CI 0.35 to 0.96; P = 0.04. Conclusion: Conservative oxygen therapy was associated with a statistically significant reduction in mortality at last follow-up compared to liberal oxygen therapy but the certainty of available evidence was low or very low due to bias, imprecision, and indirectness. PROSPERO registration number: CRD42019138931.

【 授权许可】

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